| NPI | 1831388073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY TP426) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME53220) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2018-04-23 |